An investigation of the effectiveness of family-centred positivebehaviour support of young children with disabilities

Szu-Yin Chu*

Department of Early Childhood Education, National Taitung University, Taitung, Taiwan

(Received 21 July 2013; accepted 23 November 2014)

Positive Behaviour Intervention and Support (PBIS) is an evidence-based approachthat has been proven to be effective in remediating problem behaviours in children.The purpose of this study was to evaluate the effectiveness of the family-centred PBISapproach when involving Taiwanese families in the treatment of off-task and non-compliant behaviours of three young children with disabilities. The single-subjectdesign utilised multiple measurements to monitor dependent variables. Data of twotargeted behaviours were collected in both centre and classroom settings from baselineto follow-up phases, though to meet the participating families’ needs, intervention wasprimarily implemented in the centre setting. The results revealed that participantsexhibited immediate and significant gains (i.e. a decreasing trend in the targetedbehaviours) upon implementation of the intervention and that those gains weremaintained after the cessation of intervention. Further evidence of efficacy of thisintervention was found in the improvement in parents’ ratings of acceptance of thePBIS approach and levels of parental stress. The follow-up data implied that PBISmay represent effective practices worthy of consideration for use with children ininclusive classrooms.

Keywords: family-centred; positive behaviour support; problem behaviours; youngchildren with disabilities

Introduction

The need to address problem behaviours early in childhood has been well established(Powell et al. 2007). A strong literature base exists that connects early behaviouraldifficulties to a future of more severe behavioural problems (Gettinger and Stoiber 2006;Powell, Dunlap, and Fox 2006). Research suggests that the patterns of behaviouralproblems (e.g. non-compliance, aggression) may interfere with optimal learning andprosocial engagement with peers (Powell, Dunlap, and Fox 2006). Furthermore, manychildren struggle considerably with classroom environments, which can lead to a chroniccycle of both behavioural and academic problems throughout their school years (Barnettet al. 2006; Carter and Van Norman 2010). Consequently, the trajectory for children whoexhibit problem behaviours at a young age may lead to a variety of negative outcomessuch as school failure and expulsion from the classroom (Campbell 2002; Hojnoski andMissall 2006; Walker, Ramsey, and Gresham 2004).

While determining assessment and interventions for young children with problembehaviours, a key element in effectively providing early intervention services is to

*Email: sychu@nttu.edu.tw

International Journal of Early Years Education, 2015Vol. 23, No. 2, 172–191, http://dx.doi.org/10.1080/09669760.2014.992868

© 2014 Taylor & Francis

collaborate with the family (Blair et al. 2011; Binnendyk and Lucyshyn 2009). Family-centred practice is a systematic way of creating a partnership with families. Involvingfamilies in intervention planning helps to ensure that the child’s and the family’s needsguide plans and that the interventions implemented strengthen and empower families(Dunlap et al. 2001; McLaughlin et al. 2012). Research conducted in Taiwan has alsofound that early intervention programmes with high levels of parental involvement appearto be more effective than those without (e.g. T.-L. Hsu 2006; S.-P. Hsu 2008; Tsai 2002).Legislation in Taiwan (e.g. The Special Education Act 2009) related to the developmentof pupils’ Individualised Education Programmes (IEPs) also requires that parents beincluded. Of all the factors, family-centred practices undoubtedly have positive impactson successful learning outcomes of children’s education (Chen 2011; Chu 2012).

A considerable body of literature has supported the use of behavioural trainingsinvolving families to ensure the implementation of effective strategies to promote thedevelopment of positive behaviours in children (Lucyshyn et al. 2007). Coming from thescientific approach of Applied behaviour analysis (ABA), the Positive BehaviourIntervention and Support (PBIS) model is the component of recent evidence-basedpractices designed to effectively address problem behaviours in young children, and ittakes a more supportive approach by viewing the child as an individual and evaluatingthe quality of life of the child and his or her family (Carr et al. 2002; Niew 2009). PBISincludes the family as a critical component of the intervention and views the family as co-collaborators with the professional (Dunlap et al. 2001; Minke and Anderson 2005).Family-centred PBIS views the family members as key agents in the planning anddesigning of the intervention, specifically taking the embedded cultural values intoaccount to ensure the appropriateness of the interventions by all stakeholders, includingprofessionals and family members (Blair et al. 2011; Carr et al. 2002; Wang, McCart, andTurnbull 2007).

The current study of family-centred PBIS utilised the core features described byBinnendyk and Lucyshyn (2009), including collaborative partnership, functional assess-ments, contextual fit and meaningful lifestyle outcomes. In this study, “family–professional collaborative approach” refers to the establishment of a reciprocal relation-ship in terms of communication, advocacy and decision-making in the service deliveryprocess. This partnership may include the design of intervention to promote families’ andprofessionals’ awareness and participation (Blair et al. 2011; Niew 2009; Turnbull et al.2010). Utilising the functional assessment to gather information related to the child’sinappropriate behaviour is an essential step in understanding preferred consequences oravoiding an unwanted consequence (Dunlap et al. 2001). Within the PBIS approach, it isimportant that the intervention plan fits with the family’s values, strengths, availableresources, adaptability and social support. The behavioural plan is evaluated to determineif it is congruent with the family’s values, which is considered as contextual fit (Chu2012; Wang, McCart, and Turnbull 2007). Finally, the long-term goal of PBIS seeks toproduce significant and durable person-centred outcomes and improve quality of life forchildren and families (Lucyshyn et al. 2007).

Although studies have demonstrated the effectiveness of PBIS in decreasingchallenging behaviours and promoting positive outcomes, research documenting theutility and applicability of PBIS with young children remains scarce. Previous studieseither were conducted in classroom settings or focused on certain types of disabilities. InTaiwan, there is a relative dearth of literature concerning the implementation of PBIS inearly childhood contexts, particularly involving families in the intervention process (Chu2012). Despite this, the evidence-based approach of PBIS has been proven to promote

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positive outcomes for individuals with challenging behaviours (Lucyshyn et al. 2007). Onthe other hand, research has found that families often respond to young children’sbehaviours in inappropriate ways (Wakschlag et al. 2007), suggesting that they needaccess to evidence-based intervention so they can address inappropriate behavioursappropriately (Chu 2012). Families whose children display conduct problems also tend tounintentionally reinforce maladaptive behaviours (Wakschlag et al. 2007). Consideringthe above, a need exists for involving families in the development of the behaviour-support plan process, allowing them to participate in problem-solving, understandingbehavioural function and identifying strategies that may promote positive behaviour andreduce challenging behaviour (Binnendyk and Lucyshyn 2009; Lucyshyn et al. 2007).

Taken together, family-centred PBIS suggests that by involving families in theimplementation of the intervention, they become empowered. Studies (e.g. Gettinger andStoiber 2006; Ingersoll and Dvortcsak 2006) have also shown that parent–professionalpartnerships are associated with children’s success in school. These studies were mainlyconducted in the United States. On the other hand, in Taiwan, society holds professionalsin high regard, with communication styles taking more of a top-down approach, fromprofessionals to parents, instead of the approach described in the previous studies (Ting-Toomey and Chung 2005). This difference points out that families may have differentvalues, child-rearing styles, beliefs about disabilities and types of communication thanthose held by professionals (Chu and Wu 2012; Huang 2011). Due to the high valueplaced on professionals’ perspectives, Taiwanese families are unlikely to speak up eventhough they may disagree with professionals’ disciplinary actions in the service deliveryof early intervention. These cultural differences may affect the parent–professionalrelationships (Chu and Wu 2012). Recognising the collaboration of parents andprofessional as the fundamental aspect of PBIS, the goal of this training programme isto involve families of children with disabilities in evaluating the effectiveness of such anapproach for addressing problem behaviours in meaningful contexts. The present studyalso seeks to extend the PBIS research and add to the literature based on implementingPBIS for children with different types of disabilities in a Taiwanese early childhoodcontext. The following research questions will be addressed: (1) Does PBIS decrease theparticipating children’s off-task and non-compliant behaviours in the targeted setting? (2)Does PBIS result in collateral changes in target behaviours of the children acrosssettings? (3) Does PBIS increase the participating families’ involvement opportunities?(4) Does PBIS evaluate the participating families’ social validity for the PBIS process?

Method

Selection of participants

Participants in this study were kindergarten children with disabilities and their familieswho met the following inclusionary criteria: (1) the child had an identified special need ordisability; (2) endorsement was given by the child’s family and/or teacher in at least onearea of concern regarding the child’s behaviour at home or at school (e.g. off-task,disruption, aggression, non-compliance) and (3) agreement was given by the child’sfamily to participate in this intervention.

Participants were recruited from the Chinese Association of Early InterventionProgram for Children with Developmental Delays (CAEIP) in an eastern city in Taiwan.Initially, the social workers from CAEIP contacted potential families to see theirwillingness for participating in this study. Once they agreed, the researcher contacted

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them and distributed the consent forms to the parents before the research started. Theparticipating families were asked to read carefully and sign after they approved of thecontent of the informed consent. In addition, participants from the city had the highestpercentage of school-aged pupils who were low-achieving (e.g. high rates of illiteracy).This city also comprised the highest percentage of the aboriginal population, and thechildren were more likely to have parents with limited education, have high rates ofilliteracy or be reared by grandparents. This is also one of the most economicallydisadvantaged cities in Taiwan.

Profiles of participating children, families and the trainer

One of the core features of PBIS is to consider contextual fit (Binnendyk and Lucyshyn2009; Blair et al. 2011), which refers to carefully planning interventions in conjunctionwith the families’ needs. Thus, understanding each family’s context is essential tofacilitating family involvement during this process. During the home visits, eachparticipating family provided background information related to targeted children’s andtheir needs, which was then incorporated into the intervention plan.

All participating children received one or more disability-related services in the localhospital (e.g. speech therapy). According to the results of the Receptive and ExpressiveVocabulary Test (Huang et al. 2011) three targeted children demonstrated moderate tosevere language impairment. They qualified for financial aid for treatment from theMinistry of the Interior of Taiwan. All participating adults were also the primary care-givers for the target children. A description of the participants’ demographic informationis given here.

Yuan and his family

Yuan was a six-year-old boy who had been diagnosed with autism and was placed in aninclusive classroom at a private kindergarten. He lived with his parents and his youngerbrother, who had also been diagnosed with autism. Yuan’s mother had depression andwas unable to care for her two children with autism, and his father participated in thisstudy. He was able to communicate using two- or three-word phrases and could followadults’ directions. His father said that his son frequently exhibits aggression anddisruptive behaviours, which include crying, tantrums and throwing things. BecauseYuan’s father would like for him to smoothly transfer to first grade in the generaleducation setting, he wanted Yuan to learn how to comply with adults’ requests and stayfocused.

Cheng and his family

Cheng was a five-year-old boy who had been diagnosed with a moderate intellectualdisability, attending the same kindergarten as Yuan (Cheng received a tuition waiver dueto his family’s economic status). He lived with his grandparents, two brothers who hadalso been diagnosed with moderate intellectual disabilities, and two typically developingsiblings. Cheng’s grandmother (unemployed) was the primary caregiver. He had goodcommunication skills but frequently demonstrated problem behaviours (e.g. unable tofollow directions, physical aggression towards peers). He was referred to receive servicesfrom CAEIP by a social worker because his behavioural problems affected his socialskills and learning progress. In the initial contact, we communicated with Cheng’s family

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through the social worker. The family stated that they wanted Cheng’s long-term goals toinclude attending to tasks as directed by the teacher and positively interacting with peers.

Kang and his family

Kang was a six-year-old boy who had been diagnosed with cerebral palsy and who wasreceiving education from the same school as the other two children described above.Kang lived with his grandparents, and they received social service benefits to supportthemselves. Kang’s grandmother (unemployed) was the primary caregiver. He wasnonverbal and used gestures to communicate. According to Kang’s kindergarten’steacher, he had strengths in the areas of vocal and motor imitation and problem-solvingskills, which served as a foundation to promote learning. The reason he had been referredto the programme was that Kang’s grandmother wanted him to receive more one-on-oneinstruction. Specifically, his grandmother indicated that she did not have the necessaryparenting skills to train Kang to work on schoolwork and wanted him to be involved indifferent tasks (e.g. independently complete worksheets, learn how to ask for help, andplay games with peers).

Trainers

Two trained college pupils (i.e. trainers) were assigned to work with each of the targetedchildren, of a total of six trainers included in this study. In each session, one trainerworked with the child while the other trainer assisted with data collection. Beforeworking with the participating children, these trainers took three to five courses and hadreceived 20–36 hours of practical trainings related to behavioural techniques and family-centred practices.

Setting

During home visits, the targeted families reported that they did not consider the home asan appropriate place to train their children to be involved in different tasks (because, forexample, they were living with extended family members, did not have sufficient space,could not afford to buy teaching materials, etc.). Because of the potential that homeenvironments might limit targeted children’s learning, the researcher discussed with allthe families that intervention sessions would be conducted in the quiet room at the ChildDevelopment Centre of a university in the local city. For each session, each targeted childwas scheduled in the same room from baseline to intervention phases of the study.Sessions were conducted two or three times per week, and each session lastedapproximately 60 minutes. The weekly parent–professional discussion meetings wereheld in the meeting room of the centre. All sessions were videotaped to facilitate parent–professional discussions about their children’s learning progress.

To meet participating families’ expectations, follow-up data were collected in eachtargeted child’s classroom (i.e. to confirm that transferring of training occurred in thenatural setting). Before implementing the interventions, observations were also conductedto collect data to capture targeted behaviours in the classrooms during both baseline andintervention phases. The student–teacher ratio was 1:22. Cheng and Kang were the onlychildren with disabilities in their classrooms, while there were other children withdisabilities in Yuan’s classroom. To ensure consistency across participants as well as to

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have the ability to capture targeted behaviours, observation data were collected duringcentre time.

Research design

Before implementing the intervention, functional assessments were utilised to identifyenvironmental events, circumstances and interactions that trigger and maintain problembehaviours (Dunlap et al. 2001). The direct observation and interviews were utilised toidentify the function of behaviours for each participating child, and the results of thefunctional assessments were used to develop an informed intervention plan.

This study employed a single-subject experimental design, using multiple baselinesacross subjects to document the effects of PBIS implementation on the dependentvariables (decreasing off-task and non-compliant behaviours). The study comprised threephases: baseline, intervention and follow-up. Specific procedures, including functionalassessment, are described in the next section.

Procedures

Functional assessment

The functional assessment interview was completed using a modified version of theFunctional Assessment Interview (FAI; O’Neill et al. 1997). The FAI was conducted inthe participating families’ homes and was completed in approximately 60–90 minutes.The information gathered from direct observations using an A-B-C analysis (O’Neillet al. 1997) identified events that were maintaining the problem behaviours. Theresearcher conducted two to three observations in the home and school settings during15- to 30-minute periods of targeted routines (i.e. dinner routine at home and centre timeat school). Results from these assessments revealed that the three children engaged inhigh rates of problem behaviours when adults requested that they complete non-preferredtasks (e.g. clean the table) or when adults interrupted them while they were engaged inpreferred activities (e.g. playing with cars). In addition, the data showed that low rates ofproblem behaviours occurred during participating children’s independent play or duringactivities involving high-preference materials.

Baseline

No behaviour-management techniques were used with the participants during the baselinephase. The activities (i.e. tasks and requests in different skill areas) that the trainerprovided in this phase were similar to those in the intervention phase, but no behaviouralteaching strategies (e.g. promoting, discrete trial training, positive reinforcement, etc.)were used. The targeted behaviours were observed three times in the inclusive classroomsfor each participating child. These participants were observed during the 20–30 minutecircle times. Through three informal meetings and observations in this phase, each child’sbehavioural goals were set by the researcher and each participating family.

Intervention

The same toys, materials, media and activities that were available to the children in thebaseline phase were again available in the intervention phase. The behaviour-intervention

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strategies (positive reinforcement, differential attention and escape extinction) deemedappropriate based on the functional assessment were implemented. Taking family-centredpractices as the core of this programme, family ecology information was used to ensurethat the plan was contextually appropriate (Lucyshyn et al. 2007), and the researcher andparents jointly developed plans of action and then implemented the behaviour-supportplans.

To ensure that the children engage in the tasks, the key behavioural techniquesincorporated into the teaching procedures were used for the three participants, includingerrorless teaching, variable ratio for getting reinforcer, most-to-least prompting, inter-spersing easy and hard demands, and fast-paced instruction. These techniques wereutilised to reduce children’s motivation to engage in target behaviours and to pair thework area with the reinforcement. The strategies were utilised differently for each child.For example, for the token economy, the trainer posed Yuan with two to three tasks(mixed easy and difficult demands), and he could earn one token when he completedthese tasks without demonstrating targeted behaviours. He could receive reinforcers (e.g.car or cookie) with every five tokens. The procedure was the same for Cheng, while Kanggained access to his favourite board game for one minute when he completed every fiveto seven tasks.

Follow-up

This condition was identical to baseline, wherein no intervention was implemented. Theresearcher observed each child in his or her inclusive classroom for a 20- to 30-minuteperiod to collect maintenance data on the target behaviours. Each child was observedduring centre time. The PBIS faded, and classroom teachers did not specifically use theintervention strategies (even though all teachers were aware of the implementation of thisintervention). The purpose of this observation was to collect information on the sustainedimpact of the intervention for each of the participants. The classrooms were chosen forfollow-up observations because families were concerned about the impacts of behaviouralproblems on the children’s school participation and about whether their children wereready for the inclusive learning environment.

Response definition and measurement

To design behaviour interventions that fit well with families’ needs, three familiesaddressed their stress and difficulty in handling their children’s problem behavioursduring daily routines. More data collection from those discussions is described as follows.

Dependent variable

Two problem behaviours were defined for the three targeted children. Off-task behaviourwas defined as disengaging from the learning environment (i.e. not involved in thelearning task or material), leaving the workplace, failing to complete assignments, talkingto peers and not engaging in the expected behaviour initiated by the adult. Non-compliance was defined as refusing to follow rules and failing to initiate a responsewithin five seconds of being given direction.

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Independent variable

PBIS.. The implementation of PBIS was the independent variable for this study.According to the results of the functional assessments, a comprehensive set of strategieswas designed to prevent problem behaviours and teach children new skills, makingproblem behaviours unnecessary. The intervention strategies taught to the trainers, andobserved during trainer-directed activities, were adopted from the key features of PBIS(e.g. collaborative partnership with families, functional assessments and long-termoutcomes), which was described by Binnendyk and Lucyshyn (2009). Considering thatfamily-centred practices are the core of PBIS, family ecology information was included toensure that the plan was contextually appropriate. The participating families, theresearcher and the trainers jointly developed the plans (see Table 1).

Curriculum and lesson plan. Participating children were provided with many learningtrials to practise language skills. The Assessment of Basic Language and Learning Skills– Revised (The ABLLS-R) was used as the assessment and curriculum guide. Duringtable time (i.e. on task), the trainer mixed tasks from various skill areas, including motorimitation, receptive identification of objects or pictures, and mands (requests). The taskson the ABLLS-R were developed based on each target child’s levels of skills.

Trainers’ training and support.The researcher provided training and technical support to six trainers for this study.

Before implementing the study, formal training involved instruction on the concepts ofthe PBIS approach for all trainers, including 72 coursework hours and the use of thespecified behavioural strategies (e.g. behavioural momentum, errorless teaching strategy).Videotaped examples or role-plays of each strategy were utilised, and time was providedfor questions and examples to be discussed. As for the follow-up phase, the classroomteachers of the three targeted children did not receive formal training regarding the PBISconcepts but regularly received PBIS written information sent by the researcherthroughout all phases of the study. The researcher also visited the school setting onseveral days at scheduled times to discuss the targeted strategies and answer questionsraised by the classroom teachers.

The trainers’ and participating children’s behaviours were observed during thebaseline and intervention phases. Following the formal training, limited verbal engage-ment occurred between the researcher and the trainers unless a trainer had a questionabout the use of strategies. Daily performance feedback was provided to the trainers ontheir use of strategies. Feedback meetings were held every two weeks so that the trainerscould receive continuous support. In addition, targeted behaviours as well as the use ofstrategies were reviewed during this meeting.

Parents’ role in this training.This programme emphasised working together with families. An overview of the

roles of family involvement throughout the study is provided in Table 2. Beforeimplementing this study, the researcher held a parent–professional conference for allparticipating families in the targeted children’s kindergarten classroom. Reflecting on theconcept of the family-centred PBIS approach, an emphasis on communication and mutualvaluation of partners (i.e. families and professionals) in the relationship is essential topromote children’s learning (Chu and Wu 2012). The purpose of this conference was tobuild two-way communication in order to promote a mutual understanding of eachfamily’s preferred approach to communication, their expectations, their levels ofinvolvement and their difficulty in participation.

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Table 1. Positive behaviour support plan.

Setting event strategies Preventing procedures Teach new skills Response strategies

Yuan 1. Mediate with a preferredinteraction or item to motiv-ate cooperation

2. Use visual displays to pre-dict activities in eachsession.

3. When Yuan appeared irri-tated before presenting tasks,increase positive events (e.g.a signal to predict a break)

1. Present variable ratio ofreinforcement.

2. Use “errorless teaching”strategy.

3. Use “behaviouralmomentum” techniques.

4. Intersperse easy and harddemands.

5. Use positive contingencystatements to motivate ontasks.

6. Ensure task success withmost-to-least prompt.

7. Ensure fluencyinstruction.

1. Use social board games toteach Yuan to (a) use eyecontact with instructors, (b)wait for turn-taking, (c)comply with “no” cue, (d)follow directions and (3)learn social rules.

2. Teach Yuan to use appropri-ate languages to communic-ate his needs.

1. Use escape extinction pro-cedure when engaging non-compliant behaviours

2. Use blocking and redirectingstrategies when engaged indisruptive behaviours

3. Provide praise preferreditems, or activities contin-gent on participating chil-dren’s cooperation and/orfollowing directions

Cheng 1. Give verbal information topredict activities and transi-tions in each session.

2. Promote positive interaction(i.e. paring) with trainers

3. Ensure embeddedreinforcers

1. Use behavioural contract toteach Cheng to follow rules,be cooperative and wait for abreak.

Kang 1. When Kang was ill, lowerhard tasks and decreasedemands.

2. Provide information to Kangthat helped him predict whathe was going to be do next.

3. Ensure embeddedreinforcers

1. Teach Kang to use aug-mentative and alternativecommunication system (ges-ture, sign language and pic-ture symbols) to (a) expressneeds, (b) comply rules and(c) wait for a break.

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Chu

During the intervention sessions, the trainer followed the programme guidelines thathad been developed with the families. Each session was videotaped, and familiesreviewed these video clips during monthly parent–professional meetings. After theimplementation of individual intervention sessions, the researcher provided families withopportunities to learn strategies related to behavioural techniques. Each family receivedweekly lesson plans, which were discussed in face-to-face meetings with the trainer everytwo weeks. The targeted families observed how the trainers worked with their children atleast one time every two weeks. The researcher and all the trainers reviewed data with theparticipating families on a monthly basis. During the implementation phase, Yuan’s fathertook an active role in sharing with other professionals what he learned from thisprogramme. This allowed other professionals to gain more strategies on the best way towork with Yuan. Kang’s grandmother frequently communicated with the researchersregarding Kang’s performance at home and informed them of her strengths andlimitations in assisting Kang. Although Cheng’s grandmother tended to be passivelyinvolved in the process, she provided feedback when reviewing video clips, which washelpful in modifying Cheng’s educational goals. Over the course of the programme, thetriad reviewed results, rated goal attainment for the children, and established new goals asneeded.

Treatment integrity. Data were collected by the researcher throughout the training periodregarding the trainers’ proficiency in implementing intervention strategies to ensure thatintervention components were being correctly executed. The researcher utilised a fidelitychecklist to evaluate the intervention sessions. Each checklist was scored by giving 2points to each correctly answered question and multiplying the total score by 100%. Theoverall treatment integrity for the intervention phase was 90% (range: 81–100%).

Data collection

Behavioural observation form. Observational data were collected for each child using aninterval recording technique. Data were collected in both centre and classroom settings

Table 2. Overview of family involvement.

Phase Role of family involvementParent training: behavioural

techniques

Beforeintervention

. Preliminary assessment

. Programme planningBasic concepts of ABA: behaviourfunctions, three-term contingency,consequence control, etc.

Duringintervention

. Discuss and modify goals andstrategies with professionals

. Review each session’s data withprofessionals

. Parent–professional conferenceand parent training

Intervention strategies: differentialreinforcement, promptinghierarchy, shaping, chaining,extinction, errorless teaching,discrete trial training, etc.

Afterintervention

. Involving IEP decision-makingprocess

. Develop behavioural plan withprofessional consultation

. Collaborate with teachers ininclusive classroom settings

Develop behavioural plan withclassroom teachers

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during the baseline and intervention phases. Two rows of targeted behaviours were codedon the observation form, including off-task/attending behaviour on the first row andcompliance/non-compliance on the second row. Fifteen-minute observation periods weredivided into 15-second intervals, and partial interval recording was used.

Parenting Stress Index – Short Form (PSI-SF). The PSI-SF was administered toparticipating families pre- and post-intervention to collect data regarding parenting stresslevels (Abidin 1995). The PSI-SF yields a “Total Stress” score that is made up of thescores of three scales: Parental Distress, Parent–Child Dysfunctional Interaction andDifficult Child. The Total Stress score was obtained by summing the scores on theindividual items, with a higher score indicating a higher level of stress. This measure hasbeen shown to be helpful in identifying high-stress areas, assessing family functioningand parenting skills and assisting with intervention planning. The form consists of 36items and takes approximately 10 minutes to complete. Participating families were askedto complete this form during the baseline and follow-up phases.

Treatment Evaluation Inventory – Short Form (TEI-SF). This measure (Kelley et al.1989) was used to evaluate treatment acceptability and parents’ acceptance of proceduresfor children with behaviour problems. Dimensions included acceptability, predictedeffectiveness of a given treatment and discomfort associated with treatment. It has beendesigned to measure social validity, which is concerned with the acceptability of differentdimensions of treatment, including goals, procedures and outcomes. Participating familieswere asked to answer all of the questions regarding their beliefs about this interventionprogramme. All participating families were asked to rate each item on a 5-point Likertscale ranging from 1 (strongly disagree) to 5 (strongly agree). The TEI-SF wasadministered at all assessment points (minimum is 9 points and maximum is 45 points)and was completed during the baseline and follow-up phases.

Interobserver reliability. Interobserver agreement (IOA) refers to the degree to which twoor more independent observers report the same observed values after measuring the sameevents (Cooper, Heron, and Heward 2007). The primary investigator and a second observer(i.e. research assistant who has been trained for data recoding) simultaneously andindependently recorded data on the target behaviours for at least 30% of all sessions foreach participant during each phase of the study. Data from the two observers were comparedfor agreement. An agreement was defined as the total number of times that the behaviouroccurred. Any discrepancy between the observers’ scoring resulted in a disagreement.

The IOA scores of each session were added together and divided by the total numberof sessions in which reliability data were gathered in order to calculate the overall averageIOA. The mean IOA combined across all sessions ranged from 88% to 100% (seeTable 3).

Table 3. Interobserver agreement.

Participant Phase I baseline (%) Phase II intervention (%) Phase III follow-up (%)

Yuan 100 88 95Cheng 100 92 95Kang 100 95 100

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Data analysis

Intervention data were visually analysed by plotting the percentage of intervals in whichthe behaviours were observed to occur. The rates of behaviour across baseline,intervention and follow-up periods were examined. Follow-up period refers to 4-weekobservations that were collected following the completion of the 11–17 interventionsessions. Scores from the PSI-SF were converted to percentiles and compared accordingto pre- and post-intervention. The scores of the TEI-SF were summarised and the meanscores presented.

Results

Dependent variables: off-task and non-compliant behaviours

Upon visually examining the graphic representation of the data (see Figures 1 and 2), itwas evident that all participants demonstrated positive changes in their levels of attendingand compliance from baseline to intervention. In the baseline phase, the average rates ofoff-task behaviour were 98%, 92% and 63% for Yuan (range: 95–100%), Cheng (range:90–95%) and Kang (range: 55–70%), respectively. In the classroom settings, the averagerates of this behaviour were 90%, 85% and 50% for Yuan, Cheng and Kang, respectively.When the PBIS was implemented, the per cent of off-task behaviour immediatelydecreased to an average of 61%, 60% and 30% for Yuan (range: 48–80%), Cheng (range:45–75%) and Kang (range: 22–45%), respectively. During the intervention phase, theaverage rates of this behaviour demonstrated in the classroom setting were 69%, 58% and40% for Yuan, Cheng and Kang, respectively. During the follow-up, the off-taskbehaviours maintained a decreasing trend, with an average of 45%, 49% and 25% forYuan (range: 40–48%), Cheng (range: 48–50%) and Kang (range: 25–25%), respectively.This result demonstrated that off-task behaviours decreased in a different setting.

Additionally, all participants demonstrated decreases in non-compliance followingimplementation of the interventions. In the baseline phase, the average rates of non-compliant behaviour were 93%, 71% and 54% for Yuan (range: 90–95%), Cheng (range:65–75%) and Kang (range: 45–58%), respectively. In the classroom settings, the averagerates of this behaviour were 82%, 80% and 45% for Yuan, Cheng and Kang, respectively.In the intervention phase, the per cent of non-compliant behaviour decreased to anaverage of 58%, 45% and 26% for Yuan (range: 43–79%), Cheng (range: 32–62%) andKang (range: 18–41%), respectively. During the intervention phase, the average rates ofthis behaviour demonstrated in the classroom setting were 59%, 51% and 32% for Yuan,Cheng and Kang, respectively. The compliance for three participants maintained adecreasing trend (average rates were 49%, 40% and 27% for Yuan, Cheng and Kang,respectively) in the follow-up, indicating the generalisation of such behaviour in theclassroom.

PSI-SF

In general, the normal range for scores is from the 15th to the 80th percentile. Scores inthe 85th percentile and above are considered to be high, and clinically significant scoresare typically above the 90th percentile (Abidin 1995). Participating families’ scores on theTotal Stress survey and its three subscales are presented in Tables 4 and 5. Yuan’s andCheng’s families scored in the high range on the difficult child domain at preintervention,but this score decreased to the typical range during the follow-up phase. Specifically,

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Yuan’s father scored in the significant range on the Total Stress survey, but his scoredecreased to the normal range in the follow-up phase. Overall, the scores for two of thefamilies fell to points within the typical range, and the scores in the three domains and onthe Total Stress survey decreased from the baseline to the follow-up phase for allparticipating families.

Figure 1. Percentage of off-task behaviours.

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TEI-SF

The TEI-SF includes items designed to assess families’ willingness to use this treatment,beliefs about treatment effectiveness and acceptability of using the treatment. Table 6shows the families’ ratings on the TEI-SF. The average number of points at the baselinewas 33, indicating that the participating families’ responses mainly ranged between

Figure 2. Percentage of non-compliant behaviours.

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“neutral” and “agree.” Upon implementation of treatment, the average scores were 43,indicating that after treatment, ratings of the acceptability of the PBIS improved to themaximum level possible. The results supported that the PBIS programme involvingfamilies and outcomes was acceptable and effective.

Discussion

Current education policies and practices have resulted in increased numbers of familiesof children with disabilities’ being included in the service delivery process (Chen 2011;S.-P. Hsu 2008; McLaughlin et al. 2012). This study contributes important information tothe field of early childhood special education, specifically involving families in theintervention as the foundation of improving outcomes for children with disabilities.Overall, visual examination of the data highlights improvements in off-task and non-compliant behaviours across participants. The PSI-SF indicated the decreased scores instress levels across participating families from pre- to post-intervention. Moreover, twoout of three families’ beliefs about the acceptability of the PBIS approach improved tonearly the maximum level possible by the end of the study.

As discussed previously, focusing on the behavioural and social–emotional develop-ment of young children is critical, particularly if we attempt to intervene early to halt anegative behavioural cycle and keep the achievement gap from widening (Benedict,

Table 4. PSI-SF total scores.

Percentile Yuan Cheng Kang

Total stress Baseline 88 83 63Follow-up 72 72 58

Table 5. PSI-SF percentile scores in three domains.

Percentile baseline Percentile follow-up

Domains

Parentaldistress

Parent–childdysfunction

Difficultchild

Parentaldistress

Parent–childdysfunction

Difficultchild

Yuan 80 85 90 65 70 80Cheng 77 82 85 70 75 70Kang 65 58 55 65 50 40

Table 6. Ratings of TEI-SF.

Acceptability points

Participating families Baseline Follow-up

Yuan’s father 36 45Cheng’s grandma 30 40Kang’s grandma 34 45

186 S.-Y. Chu

Horner, and Squires 2007; Hojnoski and Missall 2006). Although the intervention tookplace in a separate room from the regular classroom, an improvement trend in the dataindicates continued effectiveness of the PBIS approach throughout the follow-up phase,supporting the effectiveness of the intervention when maintained in inclusive classrooms.Data also revealed that three participating children gradually decreased targetedbehaviours in the classroom settings during the intervention phase. Following imple-mentation in different settings, it is interesting to note, children in the current studyappeared able to almost instantaneously recognise the consequences of their behavioursand regulate their actions. For example, when entering the classroom, Yuan and Chengfrequently commented to others, ‘I will complete tasks first and then go to play’. On theother hand, compared to other participants, Kang did not show high levels of off-task andnon-compliant behaviours in the baseline phase, but after intervention, the improvementsin behaviours were a clear change in the levels for all participating children. Previousresearch (e.g. Lucyshyn et al. 2007) has shown the efficacy of the PBIS approach withchildren with autism and their families, and this study revealed that such an approachcould be an effective intervention for children with other types of disabilities. Therefore,there continues to be an increasing need for evidence-based behaviour-support strategiesin order to more effectively manage disruptive behaviours in the classroom. The effectivemanagement of behavioural problems can assist early childhood educators in moving onestep closer to the goal of improving behaviour and preparing children for increasedlearning (Carter and Van Norman 2010; Gettinger and Stoiber 2006).

A collaborative partnership is emphasised in the PBIS approach (Chu and Wu 2012;Binnendyk and Lucyshyn 2009; Blair et al. 2011; Carr et al. 2002; Lucyshyn et al. 2007;Wang, McCart, and Turnbull 2007). Although there were limitations in implementing theintervention in the children’s home settings, the collaboration process helped thesefamilies create positive behaviour changes in their children. During the initial home visit,it was observed that the families tended to use punishment (e.g. verbal reprimand) tocorrect their children’s non-compliant behaviours. But during the follow-up home visit(after the intervention), the researcher observed that families used positive strategies (e.g.reinforcement, specific directions instead of scolding their children) and had started tounderstand the concepts of the behavioural techniques that were addressed during parenttraining process. For example, Yuan’s father said, ‘I think the function of behaviour isto escape from work, and I tried to ignore Yuan’s complaining’. During the PBISimplementation process, a collaborative partnership in which families and professionalsshare the responsibilities to conduct functional assessments and design the behaviour-support plan is a critical component (Binnendyk and Lucyshyn 2009; Lucyshyn et al.2007; Wang, McCart, and Turnbull 2007). Reflecting on a meaningful lifestyle outcomeas one of the core areas of the PBIS approach (Binnendyk and Lucyshyn 2009), familieswho were involved in their children’s educational process might produce long-termimprovements to the quality of life of their children.

Research has found that parents struggle with accessing and utilising evidence-basedpractices for intervening in problem behaviours in young children (Chu and Wu 2012;Epley 2009). Without adequate knowledge of techniques for intervening in the problembehaviours, professionals and families may respond to the disruptive children byproviding less instruction and fewer instances of positive feedback, causing thesechildren to ‘learn less and attend less’ (Raver and Knitzer 2002, 3). Althoughimplementing behavioural techniques requires more training and resources than mostparents have available, the current study aimed to assess the effectiveness of involvingfamilies by providing access to PBIS services. In other words, this programme targeted

International Journal of Early Years Education 187

children’s disruptive behaviours directly through the professional component (i.e.providing intervention using evidence-based practices and behavioural techniques) andindirectly through the parent component (i.e. the emphasis on PBIS concepts that parentscould understand and implement to improve family–professional collaboration). Theimproved scores of social validity on the TEI-SF measure corresponded to families’pursuing evidence-based PBIS as a treatment for their children. In the baseline phase,families marked “agree” in response to most questions of the TEI-SF measure, but mostfamilies marked “neutral” when considering the procedures used in this treatment. Oncethis treatment involving families was implemented, they received information aboutidentifying proactive and reactive strategies aligned with the functions of off-task andnon-compliant behaviours, and they changed their responses to the question aboutprocedures used in this treatment to ‘agree’ or ‘strongly agree’. Overall, it was found thatfamilies perceived the goals, procedures and outcomes to be acceptable, feasible andsatisfactory.

Family characteristics have a significant impact on the development of children’sbehavioural problems. Families experiencing high levels of stress are often the onescharacterised as having children with disruptive behaviour disorders (Spratt, Saylor, andMacias 2007). The data collected from the PSI-SF did not show that participating familiesexhibited higher levels of stress, perhaps because participants’ disruptive behaviours maynot be significantly more severe than those of samples in the previous studies. Anotherreason may be that these participating families tend to actively seek assistance or areoffered assistance from social welfare agencies. In addition, the families’ scores fell in thenormal range for “total stress” and in the domain of “difficult child” on the PSI-SFmeasure, with Yuan being the exception. According to findings of previous studies,raising children with autism is more stressful on parents than raising either typicallydeveloping children or children with other disabilities. Although all participants’ PSI-SFscores showed a decrease in stress ratings in the follow-up phase, whether thisprogramme has a positive impact on reducing parental stress level is inconclusive.

Limitations

There were several limitations in this study. First, a continuous threat to validity in single-subject designs is the small sample size. In this study, that threat was exemplified byhaving only three participants; findings are based on participant characteristics.Specifically, these participants were recruited from one city in Taiwan. The findingscannot be generalised to all Taiwanese children with disabilities who exhibit off-task andnon-compliant behaviours. In addition, there was a weakness in the analysis ofgeneralisation. The collection of generalisation data was limited. Although the familiesconsidered the school setting as a priority, it could have been beneficial to extend datacollection to the home settings to determine the sustainability of skills over a longerperiod of time. Third, this study did not control threats to confounding variables, such asreceiving services from other professionals or in-home intervention programmes. Forexample, Yuan received continuous intervention services at home two times per week,while Cheng and Kang did not. Although this study did not compare the effects of suchintervention programmes on each targeted child’s performance, the levels of intensity ofintervention might be a confounding factor that warrants further attention.

188 S.-Y. Chu

Future directions

Despite the fact that the evidence showed the effectiveness of home-and-schoolcollaboration on interventions for decreasing disruptive behaviours, it is unknownwhether families actually ascertained the concepts of PBIS for their children. Specifically,behavioural consultation was provided throughout the whole study; however, we do notknow for whom consultation was effective or what factors in the home environment mayhave impacted treatment effectiveness. In other words, further research is necessary toinvestigate the effectiveness of implementing the evidence-based behavioural techniqueswithin professional consultation at home.

Positive behaviour support is a data-driven approach that can assist in themanagement of problem behaviours within the classroom. In the current study, the datain both intervention follow-up phases showed clear collateral advantages to using thePBIS approach, although no intervention was implemented in the classroom settings.Future research is suggested to investigate the generalisability of study results,specifically when implementing in a group format. Given a higher student–teacher ratioin the classroom setting and difficulty in finding qualified personnel to deliver one-to-oneinstruction, additional study is needed to evaluate the effectiveness of group instructionusing positive behaviour support. Utilising a group format may increase generalisationand social advantages.

In summary, this study suggests that coordinating closely with professionals andinvolving families in the intervention may lead to more pronounced and generalisedbenefits. Working with families can help lay the foundations for school success and apositive school–family relationship, which may result in correlated gains in children’slearning outcomes.

Disclosure statementNo potential conflict of interest was reported by the author.

FundingThis research was supported by a funding grant from the National Science Council, Taiwan [grantnumber 101-2410-H-143-008] to the National Taitung University. The work was conducted to thehighest ethical standards and the findings faithfully reported.

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